Purnima Coontoor meets Dr G Gangadharan, the medical director of I-AIM, an ayurvedic health centre that has received many awards and accolades for ground-breaking research and excellence in healthcare
When I recently remarked to my friends that I had shifted from allopathy to ayurvedic treatment for a chronic health condition, some of them were sceptical. Especially some friends from the West, a couple of them practising doctors of allopathy. “What!” they protested, “Why?”
“For one, with ayurveda I am sure I am not dumping my body with toxins,” I replied.
“Herbal concoctions are not necessarily benign – the process of ayurvedic formulations can introduce a lot of chemicals into them. Let us not forget that it is a multi-million dollar industry and there is ample scope for all kinds of process and quality control issues,” said one.
“All herbs are not good for health. Marijuana is a herb too,” said another, cheekily.
“I don’t know if ayurveda can be classified as a codified form of medicine, it is more like a healthy lifestyle that could prevent many ailments of the modern-day life,” remarked yet another.
“For ayurveda to progress, it has to adopt the tried and tested scientific methods of objective analysis, experimentation, biostatistics, and clinical trials. I fault the lack of concerted vision, management and professionalism in the field,” lamented an advocate of ayurveda.
Being a beneficiary of various churnas, lehyas and kashayas from my grandfather, an ayurvedacharya, all my life, I was at the outset peeved at what I considered a biased, unkind criticism of a divine science bequeathed to mankind by our forefathers. But then, I realised, these were very valid concerns that many more people could have with regard to ayurveda. Individual faith, pride in heritage, and personal experiences of well-being, hardly counted as scientific to induce belief in this system. If ayurveda had to reach the masses on a larger scale, and claim its rightful place as a preferred first line of therapy by health seekers and medical practitioners the world over, such concerns needed to be addressed.
My mind buzzing with these questions one fine morning, I entered the sprawling premises of the Institute of Ayurveda and Integrative Medicine (I-AIM), a specialised research and health services hospital located on the outskirts of Bangalore. Established in 1993 by visionaries Sam Pitroda and Darshan Shankar, it was then called the Foundation for Revitalization of Local Health Traditions (FRLHT). Now funded totally by Ratan Tata’s Trusts, it has engaged in research and healthcare, with the mission of providing efficacious, safe and cost-effective healthcare solutions for contemporary health problems, through creative applications of traditional health systems suitably integrated with bio-medical sciences. Through the years I-AIM has received many awards and accolades for ground-breaking research and excellence in healthcare (www.iaimhealthcare.com).
My spirits lifted immediately on entering the verdant landscape of I-AIM; the vivid and fresh colours of nature that surrounded the hospital were soothing, the breeze from the herbal garden rejuvenating, the ambience welcoming. This was no hole-in-the-corner affair that one tends to associate with alternative medicine practice. With its state-of-the-art modern research and diagnostic laboratories, airy, cheerful therapy units where traditional ayurvedic treatments are dispensed, the hundred-bed hospital catering to patients of different needs, I-AIM could well be mistaken for a sophisticated modern hospital in terms of infrastructure, efficiency and professionalism. If it lacked something, it was the sterility and the distinct smell of tincture of the latter.
I eagerly stepped into the cabin of Dr G Gangadharan, the medical director of the healthcare centre, ready with my questions. An expert on authentic ayurvedic methods of diagnosis and treatment – especially pulse diagnosis, he is successfully treating lifestyle disorders and has dedicated himself to the propagation of ayurveda and local health traditions at the grassroot level in rural parts of India. Unassuming, yet inspiring confidence in patients with his warm and decisive manner, Dr Gangadharan readily addressed most of the concerns that confront ayurveda and traditional medicine at present.
What is health, according to ayurveda?
Ayurveda describes health as equilibrium. Vata, pitta and kapha, called the ‘tridoshas’ are the functional units of the body. Kapha molecules constitute the cellular as well as intracellular structure of the body, and maintain its internal environment. They impart strength and stability to the body. Pitta molecules are responsible for all the biochemical reactions and metabolic processes of the body. All the enzymes and hormones belong to the category of pitta molecules. Vata molecules control the movements of pitta and kapha molecules and control all the functions and activities of life. The active components of vata molecules constitute the neurological impulses.
The achieving of equilibrium among the three systemic functions – metabolism, body tissues and the excretory process – with the senses, the mind and the atman (the inner-most self) is a state of health.
Only an experienced physician can determine a person’s prakriti (nature), determine the imbalance, and treat the same.
It is often felt by the layman that while ayurveda is best suited to cure chronic illnesses like BP or diabetes, one cannot depend on it in emergencies like heart attack or kidney failure.
The noticeable aspect here is surgery. Though ayurveda speaks of shalya tantra (surgery), it is not a living tradition like ayurveda medicine and panchakarma treatments are. Even if it were in vogue till date, there would hardly be any difference between it and modern surgery. Heart and kidney failures and such, at their critical stage, call for surgical and other invasive treatment. Hence the limitation of ayurveda in such instances.
Ayurveda primarily speaks of diet and lifestyles required for keeping fit physically, mentally and spiritually. Preventing the onset of (chronic) illnesses comes first, therapeutic ayurveda comes next.
Most people are used to popping pills because they find instant relief for conditions like headache or stomach ache. Can ayurveda provide such relief?
To pinpoint the ‘hetu’ or the causative factor is very important for precise treatment. Many a time ayurveda physicians are unable to do this ‘pratyaneeka-nidana’ (differential diagnosis). So we give a broad-spectrum medicine that will work immediately in some cases, and not so in others. It is not true that ayurveda cannot work in acute conditions.
Ayurveda lays stress on correct diet and lifestyle. How practical is it in modern times?
It is not correct to say that ayurvedic prescriptions are not practical in modern times. Modern diets also can be healthy from an ayurveda point of view. Ayurveda advises you to shun junk food, especially processed food. White sugar and maida are examples of incorrect foods. Many of the additives, preservatives, colouring agents, and taste boosters are harmful to the body whether considered from the ayurveda angle or modern scientific view. For example, strawberry flavour is made by synthesising 41 chemicals. There is no natural strawberry in it at all. Ayurveda highlights such examples to save the gullible from the onslaught of harmful foodstuff and gives a call for organic food. Hence ayurveda is always practical. But the ayurveda principle has to be contemporised. That should be the role of the physicians.
An organisation called CISSA holds a 5-day ANNAM festival every two years. Many foods made from natural products which are tastier, healthier and more cost effective than junk food are available there. Please visit www.cissa.co.in
Can ayurvedic medicines be taken along with other therapies like allopathy/homeopathy?
Drug interaction is a new area of inquiry in modern science. Many of these interactions are not well understood. Most allopathic medicines will be metabolised in the tissues in 30 minutes. So we prescribe a gap of 30 minutes between intake of allopathy and ayurveda medicines. But blood-thinning treatments should not be done twice – once in allopathy and then in ayurveda. Else it will result in internal bleeding. Such intrinsic understanding is necessary on the part of ayurveda physicians. One should evaluate the action of allopathic medicines before prescribing ayurveda medicines.
Homoeopathic medicines are very mild, and to my understanding even the strong aroma of some ayurvedic medicines can nullify their effect. So, homoeopathic medicines should be stored away from ayurvedic medicines. There should be at least two hours’ gap between consumption of the two.
Coming to I-AIM, what does ‘Integrative Medicine’ in its name indicate?
True practitioners of ayurveda have resorted only to classical medicines that have never failed to deliver what they promised ages ago. Nevertheless, it is the age of integration. No single system shall be fully resorted to. People discern the good in every system and resort to them accordingly. Just as invasive procedures of modern medicine are helpful, ayurveda can cater to the treatment of ortho- and lifestyle-related chronic ailments (diabetes, bronchitis, stress, etc.), and home remedies for primary healthcare to a great extent. India should take up the initiative of developing a healthcare model pivotally based on ayurveda by integrating traditional and modern systems. As a first step it should document the commonality among the various local traditions like ayurveda, siddha, and folk medicines, and then proceed to integrate them with global (glocal) systems.
I-AIM is an honest, successful effort in that direction.
There are a lot of concerns regarding professionalism in ayurvedic practice. Do ayurvedic drug companies engage in drug research and clinical trials? If so, who sets the policy and process for those trials?
Modern science has grown by questioning the veracity of the propositions even though the propounders would have exercised enough care before placing it before the fraternity. Time-tested over a few millennia, ayurveda stands a better chance to come out successful if cross-examined every which way. But the fact is that it has not passed through that phase for reasons ranging from ignorance to callousness on the part of the policy makers; ayurveda should be subject to such scrutiny.
It was only recently that the Department of AYUSH- Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy, Government of India, stipulated protocol for clinical studies on AYUSH drugs (www.indianmedicine.nic.in). AYUSH has made it mandatory to do drug trials before introducing any new drugs into the market, even if the components of such medicines are well explained in the texts.
What about quality control and who is the gatekeeper?
The Drug and Cosmetic Act has dedicated chapters for Ayurveda drugs. In 2003 Good Manufacturing Practices (GMP) were made compulsory for AYUSH industry. Quality control is done by the drug control authorities of the individual states. A Deputy Drug Controller with a team of Ayurveda experts is usually deputed by the Dept. of AYUSH for the same. Recently, WHO has initiated a post-marketing drug surveillance system in collaboration with GoI. One such centre is the Gujarat Ayurveda University (GAU) in Jamnagar, Gujarat. There are few others in other parts of the country also.
Are there scientific publications where ayurvedic researchers can publish their clinical findings and drug test results?
There are a few including one published by us called J-AIM: Journal of Ayurveda and Integrative Medicine (www.jaim. in). Ancient Science of Life is published from Coimbatore.
What are the main challenges that an ayurvedic practitioner faces?
Authentic raw material and many important drugs are no more available. More than 200 species of medicinal plants are either extinct or threatened. Important medicines like guggulu will no more be available in about 10 years unless urgent measures are taken for its conservation and propagation. Also there are no good ayurveda hospitals where critical cases can be referred to for further treatment. There are no peer group discussions on newer diseases, challenges and treatment outcomes. A plethora of unscrupulous ayurveda colleges without any facilities are mushrooming and churning out untrained graduates into the ayurveda fraternity. This is killing its future.
There are concerns about drug toxicity in ayurvedic formulations too. Are the herbs used in them organically grown?
Fortunately yes, for 95 per cent of it comes from the wild and roadsides. Nevertheless, we do not have any quality check for the heavy metal absorption, or contaminants in the herbs collected from human habitation.
Any final thoughts?
In principle, ayurveda lends itself to an integrative approach. Historically it has been progressive, dynamic and inclusive. Charaka, the sage-physician, spells out this outlook in the Charak Samhita “The science of life shall never attain finality. Therefore, humility and relentless industry should characterise your endeavour and approach to knowledge. The entire world consists of teachers for the wise. Therefore, knowledge, conducive to health, longevity, fame and excellence, coming even from an unfamiliar source, should be received, assimilated and utilised with earnestness.
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